# Nurses’ perception of epidural services in a Johannesburg academic setting

## TL;DR

This study explores how nurses in a Johannesburg hospital perceive the labor epidural service and identifies challenges affecting its sustainability.

## Contribution

The study provides insights into nurses' perceptions and challenges in sustaining labor epidural services in a South African academic hospital.

## Key findings

- Nurses expressed a positive sentiment but identified staffing shortages and lack of training as challenges.
- A short-lived increase in epidural use followed by a decline was observed.
- Education and supervision were highlighted as key factors for improving service sustainability.

## Abstract

Labour pain is associated with detrimental maternal and foetal physical and psychological effects. Labour analgesia is a basic right for all women and labour epidural analgesia has been accepted as the gold standard for providing such, with reported improvement in patient satisfaction. In South Africa, studies have shown that labour epidural rates are low. At an academic hospital in Johannesburg, a 24-h labour epidural service combined with an awareness campaign and educational programme (LEAP) was initiated with the aim of improving labour epidural rates. Results showed a short-lived uptake with a subsequent decline.

This study explored the experiences of labour ward nursing staff regarding the labour epidural service at this academic hospital including perceived limitations and possible recommendations regarding improving service provision.

A qualitative, descriptive and exploratory study was conducted. Purposive sampling was used with semistructured, audio-recorded individual interviews, thematic analysis was performed using Braun and Clarke’s six-phase approach.

The key theme is required education and supervision of epidural insertion (see page 3), management of childbirth and challenges related to epidural service provision.

A positive sentiment was expressed by the participants; however, deficiencies in the service such as shortages of experienced personnel, work constraints and insufficient training may be affecting service sustainability. Further studies are recommended to form guidance towards the development and implementation of interventions to improve service delivery.

Provision of continual training and increased staffing of healthcare personnel will help improve the sustainability of the labour epidural service.